Can you say Collaboration with Innovation? Strategic Directions for Health Libraries

1. Can you say Collaboration with Innovation? Strategic Directions for Health Libraries Rebecca Zakoor St. Michael’s Hospital, Toronto

2. Healthcare Trends • Electronic Health Record –Integration of resources into the EHR (PRIVACY) • Programmatic models of healthcare delivery • LHIN’s – Local Health Integration Networks • Consortial/provincial licensing-Knowledge Ontario • Patient centric portals

3. Moving to an EHR • In 2005 in Canada, 322 million office-based physicians visits-94% resulted in handwritten paper records. • Approx. 2,000 health care transactions per minute, many quite complex, and all requiring documentation and information flow.

4. Electronic Health Record • In November 2002, the Romanow Commission issued Building on Values:  The Future of Health Care in Canada (hereafter “the Romanow Report”), emphasizing the importance of electronic health records as “one of the keys to modernizing Canada’s health care system and improving access and outcomes for Canadians ”

5. Experience as a Patient • Online results for tests while you wait • Every physician/healthcare provider you see has your history, etc. right in front of them, in electronic format • Privacy of your records-PHIPA 2004 Personal Health Information Protection Act

6. PHIPA Personal Health Information Protection Act-2004 • Sets out rules that healthcare providers must follow when collecting, using and sharing your personal health information. • Gives you the right to see your health records and correct any mistakes.

7. EHR • National Electronic Health Record-Canada Health Infoway • Smart Systems for Health (SSHA) Ontario Government-e-Health

8. Smart Systems for Health • SSHA’s suite of products and services - Ontario Network for e-Health (ONE™) - create electronic connections that improve the flow of patient information between health care professionals.

10. Electronic Health Record-Canada Health Infoway http://www.infoway-inforoute.ca/en/home/home.aspx Electronic Health Records help improve the Access, Quality and Productivity of Canada's Healthcare System.Infoway invests with public sector partners Canada-wide to implement and reuse compatible health information systems to support a safer, more efficient healthcare system

11. EHR Electronic Health Record • EHR Improves Access • Ability to Access Care: Improved wait times and capacity to deliver needed services • Patient Participation: Patient access to the electronic health record. • Availability: Greater access to healthcare services in the home and community

12. EHR Electronic Health Record • EHR Increases Quality • Safety: Fewer medical errors and adverse drug events • Effectiveness: Achieving desired health outcomes • Appropriateness: Informed prescribing and clinical decision-making

13. EHR Electronic Health Record • EHR Increases Productivity • Efficiency: Reduced administrative time and costs • Care Coordination: Complete patient information for sharing across the continuum of care

14. Electronic Health Record • Electronic health record for children already in place- http://www.echn.ca/ • eCHN's vision is that electronic health information in Ontario and Canada should be a universal system that is inter-operable, comprehensive, accessible, flexible and available in a secure and controlled environment.

15. Electronic Child Health Network- eCHN • eCHN (electronic Child Health Network) is a non-profit, government-funded organization dedicated to providing electronic solutions that permit the sharing of healthcare information among authorized healthcare providers.

16. Information Provision in Healthcare • Information is core to the Healthcare system. • In 2005 in Canada, 60,000 physicians faced 1.8 million new medical papers in 20,000 journals and 300,000 clinical trials. • JIT Delivery/Just in Time/Research/Teaching • Print- being replaced by electronic to some degree. • Physical spaces- reduced-virtual collections.

17. Information Provision in Healthcare • Biggest challenge – integrating our Resources/Tools at the Point of Care • Handhelds- JIT Delivery-Tablet PC’s, Carts, PDA’s. • Improving Patient Care-ultimate mission • Strategy must be intertwined with that of the healthcare institution • COLLABORATION with all the players – Information Technology, Research, Administration

18. Programmatic Models of Healthcare Delivery • Programmatic structure within larger health libraries –SMH one of the first. • Information specialists need to be COLLABORATING and integrated into various programmatic teams • VALUE-Research/ Teaching • Clinical librarians; patient education; policy development

19. Local Health Integration Networks (LHIN’S) • Created based on the idea that people know what kind of health care services they really need close to home. • www.lhins.on.ca/english/main/home.asp • 14 LHINS

20. Ministry of Health and Long-Term Care-Ontario LHIN’S • Map out priorities for health system transformation at the local level in Integrated Health Service Plans (IHSP’s). • Part of each LHIN’s IHSP is an e-Health strategy that supports/enables health service providers in ensuring clients receive safe, high quality, effective and efficient health services.

21. What’s e-Health? • Ontario Hospital Association definition: “…a consumer or client centred model of health care where stakeholders collaborate utilizing Information and Communications Technology, including Internet Technologies, to manage health, arrange, deliver and account for care, and manage the health care system” E-Health helps everyone in health care work together better for benefit of all those who participate in the system, including consumers, providers and organizations.

22. LHIN’s and Health Libraries • Examination of health library services and consideration of new methods for delivery of resources and provision of library/research services province-wide

23. Health Sciences Information Consortium of Toronto ( HSICT) • Successful model of collaboration for 17 years! Emulated elsewhere. • 30 Teaching and Community Hospitals and Healthcare Institutions • Achieving cost savings, facilitating professional development, and providing valuable instructional programs-not just licensing! • COLLABORATIVE collection development. • Union List journals/SIRSI development

24. Health Sciences Information Consortium of Toronto ( HSICT) • Strategic Issues Subcommittee has established, in consultation with the Consortium membership and Board, a set of guiding principles that are essential to any discussion of a new model for health library service in the province of Ontario. • Consortial/Provincial licensing-COLLABORATION • Recommendations to be made to the LHIN’s. • HSICT is GTA centric/straddles LHIN boundaries

25. Model for Information services for health professionals in Ontario • Comprehensive svc delivery-access, training, reference, research-support quality patient care, research and teaching • *Scope-needs of medical/allied health professionals who don’t have cross appt’s to universities, other institutional affiliations, or other means of access • Specialized collections-ie: pediatrics, mental health, geriatrics, rehabilitation, oncology, etc.

26. Model for Information services for health professionals in Ontario • Professional expertise-onsite reference, orientation, training and support • Hospital accreditation-Lib/inf services must support Canadian Council on Health Services Accreditation standards. • Local needs and priorities/LHIN’s • Licensing funded by MOHLTC would free up funds within institutions (change in gov’t?)

27. Ontario Health Library Service Model • Structure? • Funding model/business case Members with full library services Partner members who contract for library services Governance? University controlled (NO)-not by one

28. Consortial/Provincial Licensing-University Centric Models Health Sciences Information Consortium, Toronto McGill University-difference-same network backbone shared by hospitals. Hamilton-McMaster

29. University Managed Models University of Manitoba-No remote access Queen’s University- fee for service-closed local hospital libraries University of Alberta and University of Calgary-Health Knowledge Network – HKN-hospitals, organizations, individuals can buy memberships. COAHL Consortium of Academic Health Libraries – cooperative of six medical schools

30. Regional and Provincial Models e-HLbc- 2006- Electronic Health Library of BC- Health authorities, post secondary instit’s, provincial ministries, Coll of Physicians and Surgeons… Saskatchewan Health Information Resources Partnership NOVL-Northern Ontario Virtual Library-Northern Ont. School of Medicine Knowledge Ontario! Public Health Div-OMHLTC Province of Quebec-4 geographic regions/one per medical school-RUIS

31. Other Initiatives • Ontario MD – province’s physicians- Ontario Medical Association. • Nurse One- Canadian Nurses Association Portal June 2006 • Canadian Health Libraries Association (National Network of Libraries for Health)-possibility of linking health libraries nationally.

32. Provincial/consortial licensing • $$$ being spent that is duplicated – duplicate access ie: physicians, nurses • Number of initiatives-need to bring them all together common direction. • Smaller libraries/remote libraries.

35. Patient Centric Portals • Web based personal health application that can integrate with a patient’s electronic health record, supporting the patient in management of his/her own health care

36. Patient Centric Portals • Chronic Kidney Disease Patient Portal initiative -December 2006-online tool for Ontarians with chronic kidney disease – management of their own care-operational by March 2008 • Grand River Hosp, Hamilton HS, University Health Network and Canada Health Infoway. • Better adherence to care plans. • Secure login process

37. Strategic Future for Health Libraries • EHR Integration- Point of Care Tools and presence • Continuation of Programmatic Models-Integration into health teams • LHIN’s – Local Health Integration Networks-Models for delivery of information services • Consortial/provincial licensing-increase • Patient portals/access/patient education

38. Questions?